Case 5 - Hypercalcaemia

Question 1

How does hypercalcaemia present?

Answer 1

Stones, goans, bones, psychic moans

• Kidney stones
• Bone pain
• Abdominal pain/constipation
• Nausea and vomitting
• Depression

Question 2

How does hypercalcaemia occur in those with bone mets?

Answer 2

Increased osteoclast activity

Question 3

Investigations for hypercalcaemia

Answer 3

• Bone profile
• PTH - distinguish between malignancy vs hyperparathyroidism

Question 4

Acute management of hypercalcaemia

Answer 4

• Correct dehydration with 0.9% saline
• Bisphosphonates IV - prevent resorption of bone, inhibits osteoclasts
  Eg Zoledronic acid or Pamidronate

Question 5

How quickly do bisphosphonates work?

Answer 5

take 6-12 months to work

Question 6

Common causes of hypercalcaemia

Answer 6

• Malignancy - bone mets, myeloma or PTHrP
• Primary hyperparathyroidism
• Sarcoidosis
• Vitamin D intoxication
• Thyrotoxicosis
• Lithium
• Tertiary hyperparathyroidism

2 main in bold